The combination of abdominoplasty and liposuction

Variants of liposuction and their effect on the results of abdominoplasty

The introduction of liposuction into clinical practice significantly increased the possibilities of plastic surgeons in the aesthetic correction of body contours. Variants of combinations of liposuction and abdominoplasty are diverse, and the choice of a surgeon is based on an understanding of those features of the influence of liposuction on the results of abdominoplasty, which are inherent in a specific operation performed.

First of all, it is obvious that the combination of liposuction and abdominoplasty, improving the possibility of correcting the contours of the body, can significantly worsen the conditions of healing of the main wound. The pathogenetic mechanisms of this effect are:

• general influence of additional (associated with liposuction) tissue trauma on the patient's general condition, and consequently, on the course of reparative processes in the main wound;
• direct influence on the processes of healing of the main wound (formed after abdominoplasty) in those cases when beside it there is a damaged zone during liposuction.

This determined three basic variants of the surgeon's tactics, which involved performing liposuction before abdominoplasty (a separate stage), during the plasty of the anterior abdominal wall and after this intervention (the second stage).

Preliminary liposuction

Preliminary liposuction is indicated with an excessively large thickness of the subcutaneous fat layer on the anterior abdominal wall, which can worsen the aesthetic result of the operation and increases the likelihood of postoperative complications. This also applies to the situation where the main fat "trap" is located along the midline of the abdomen, but the patient refuses from vertical abdominoplasty. In these cases, liposuction of the abdomen (in particular, the epigastric region) in combination with the treatment of flanks and lateral surfaces of the trunk can significantly reduce the thickness of the skin-fat flap and thereby improve the outcomes of subsequent abdominoplasty. It is understandable that the period between these two interventions should be at least 3-4 months.

Liposuction during abdominoplasty

It has now been established that liposuction in areas adjacent to the main wound significantly worsens the conditions of its healing and increases the likelihood of complications. If liposuction is carried out through the wall of the main wound (for example, treatment of the lateral abdomen and flanks), then the latter is connected by numerous channels to the liposuction zone.

As a result, the wound exudate, which is formed in a significant amount in the area of adipose tissue removal, is able to move to the main wound of the anterior abdominal wall, which determines the high probability of formation of sulfur.

For these reasons, only three variants of the operation have become available in clinical practice:

• limited liposuction of the edges of the main wound (during any variant of abdominoplasty) to eliminate (reduce) the formation of "ears" at the extreme points of horizontal access and (or) the convexity of the cutaneous seam in the epigastric region that occurs with vertical abdominoplasty;
• significant liposuction in the flanks and lateral sections of the trunk, which is performed from additional accesses removed from the main wound, in connection with which the wound zone of liposuction is not directly related to the main wound;
• moderate liposuction, which is performed through the wall of the main wound with a minimal detachment of skin-fat flaps and formed in the wound of the "dead" space.

Significant liposuction through the wall of the main wound with extensive detachment of skin-fat flaps (during abdominoplasty) is dangerous because of the high incidence of postoperative complications.

Liposuction after abdominoplasty

The performance of liposuction after abdominoplasty is usually the least preferred option for correcting contours of the figure, since thinning of the subcutaneous fat layer of the anterior abdominal wall leads to relaxation of the skin and worsens the aesthetic result of abdominoplasty. Exceptions to this rule arise with a significant difference in the thickness of the tissues, located above and below the scar line. Additional liposuction may also be appropriate when forming the "ears" at the extreme points of the horizontal scar.